Modifier 59 Clarification

CMS recently issued a clarification on existing policy regarding the use of modifier 59. A Medlearn Matters (MLN) article on the proper use of modifier “59” reduces this modifier’s applicability to ophthalmic procedures. CMS’...
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Testing for PQRI Readiness

If you are planning to participate in the voluntary Physician Quality Reporting Initiative (PQRI), you should test your billing system to ensure transmission of the quality data code to your Medicare carrier. Prior to July...
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Modifier – GY and Refractions

It is well known in the ophthalmic world that Medicare does not cover refractions. They are noncovered by statute. Statutory exclusions from the Medicare program do not require an Advance Beneficiary Notice (ABN). They...
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CMS Ruling for Toric IOLs

The Centers for Medicare and Medicaid Services (CMS) published Ruling No. CMS-1536-R allowing beneficiaries to choose implantation of an intraocular lens that corrects pre-existing astigmatism at the time of cataract surgery. The January 22,...
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